TY - JOUR
T1 - Distance management of spinal disorders during the COVID-19 pandemic and beyond
T2 - Evidence-based patient and clinician guides from the global spine care initiative
AU - Haldeman, Scott
AU - Nordin, Margareta
AU - Tavares, Patricia
AU - Mullerpatan, Rajani
AU - Kopansky-Giles, Deborah
AU - Setlhare, Vincent
AU - Chou, Roger
AU - Hurwitz, Eric
AU - Treanor, Caroline
AU - Hartvigsen, Jan
AU - Schneider, Michael
AU - Gay, Ralph
AU - Moss, Jean
AU - Haldeman, Joan
AU - Gryfe, David
AU - Wilkey, Adam
AU - Brown, Richard
AU - Outerbridge, Geoff
AU - Eberspaecher, Stefan
AU - Carroll, Linda
AU - Engelbrecht, Reginald
AU - Graham, Kait
AU - Cashion, Nathan
AU - Ince, Stefanie
AU - Moon, Erin
N1 - Publisher Copyright:
© Scott Haldeman, Margareta Nordin, Patricia Tavares, Rajani Mullerpatan, Deborah Kopansky-Giles, Vincent Setlhare, Roger Chou, Eric Hurwitz, Caroline Treanor, Jan Hartvigsen, Michael Schneider, Ralph Gay, Jean Moss, Joan Haldeman, David Gryfe, Adam Wilkey, Richard Brown, Geoff Outerbridge, Stefan Eberspaecher, Linda Carroll, Reginald Engelbrecht, Kait Graham, Nathan Cashion, Stefanie Ince, Erin Moon.
PY - 2021/2
Y1 - 2021/2
N2 - Background: The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective: The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods: Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results: The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient’s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions: The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.
AB - Background: The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective: The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods: Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results: The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient’s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions: The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.
KW - COVID-19
KW - Clinical guides
KW - Evidence-based
KW - Evidence-based care
KW - Guide
KW - Low- and middle-income communities
KW - Management
KW - Physical distancing care
KW - Spinal disorders
KW - Spine
KW - Telehealth
KW - Telemedicine
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U2 - 10.2196/25484
DO - 10.2196/25484
M3 - Article
C2 - 33471778
AN - SCOPUS:85101886987
SN - 2369-2960
VL - 7
JO - JMIR Public Health and Surveillance
JF - JMIR Public Health and Surveillance
IS - 2
M1 - e25484
ER -